The Scientific Advisory Committee on Nutrition (SACN) published its final report on The influence of maternal, fetal and child nutrition on the development of chronic disease in later life in June 2011. The SACN Subgroup on Maternal and Child Nutrition (SMCN) reviewed the evidence that early life nutrition can exert long-term effects on health and influence the risk of chronic disease in adulthood, and considered the implications for maternal and child nutrition in the UK.
Chronic diseases such as cardiovascular disease (CVD), type 2 diabetes and cancer are major causes of death in the UK. The causes are very complex, but diet and lifestyle play a significant part. Evidence from observational and experimental studies has shown that growth in early life is associated with the development of adult chronic diseases. Normal growth and development processes can be disturbed if there is an imbalance in the supply of energy and nutrients during early life and it is hypothesised that the resulting changes in pace and timing of early growth may alter body composition and function, thus influencing the risk of developing later chronic diseases.
Experimental studies carried out in animals have identified ‘critical periods’ in early development when alteration of nutrient supply may have irreversible consequences on body structure and function. This phenomenon is known as ‘nutritional programming’.
A mother’s nutritional status at the start of pregnancy is important as this influences her ability to meet the nutrient demands of the growing fetus. Low nutrient status for some vitamins and minerals (e.g. folate and vitamin D) has characterised effects on pregnancy, however the effects of an inadequate supply of many other individual nutrients are not fully understood.
How newborn infants are fed also influences their rate of growth and the type of tissue deposited. Studies show that breastfed infants have a more desirable pattern of growth associated with better health, compared with infants that are bottle fed.
Observational studies have found that lower birthweight is associated with an increased risk of chronic diseases, including coronary heart disease (CHD), type 2 diabetes and certain cancers, such as breast cancer. Low birthweight is also associated with higher body mass index (BMI) in later life. However, the exact relationship between birthweight and later chronic disease risk is complex.
Birthweight is commonly used in observational studies as an indicator of nutritional adequacy during fetal development, however weight at birth may be influenced by many other factors and therefore is not necessarily a good indicator of newborn nutritional status.
The evidence relating to infant feeding practices is inconsistent. However, infants who have not been breastfed have been found to have slightly higher blood pressure and cholesterol concentrations in adult life. They are also more likely to become obese and may be at greater risk of developing type 2 diabetes.
SACN concludes that there is cause for concern about the later health consequences of inadequate or excessive nutrient supply during early fetal and infant life. It notes that in the context of reproduction, the impact of current dietary patterns on women and girls is of particular concern, and considers that improving the nutritional status of women of childbearing age, infants and young children has the potential to improve the health of future generations. The Committee also offers recommendations for future research in this area, emphasising in particular the need for data which better determine dietary patterns and how these relate to pre and postnatal growth.
Public health recommendations
SACN makes six public health recommendations in the report, which are summarised as follows:
- Adequate nutritional status in the mother prior to conception is essential for optimum fetal development and therefore dietary and lifestyle changes in childhood and adolescence are needed in order to ensure adequate nutrition in young women throughout their reproductive years.
- Efforts to improve diet quality will need to address health inequalities and consider the diet as a whole. Existing advice to increase fruit and vegetable intake should be followed alongside appropriate supplementation with folic acid and vitamin D.
- Adolescent and young adult women need to achieve a body composition and metabolic capacity capable of meeting the stresses of pregnancy as well as their own requirements. This will help to address the health and economic implications of the rising prevalence of maternal obesity for future generations.
- There are substantial reproductive risks associated with excess maternal body weight and there is therefore a need to support women in achieving and maintaining a healthy weight before becoming pregnant.
- The increased nutritional vulnerability of underweight women needs to be addressed. Adolescent and young women who become pregnant before completing their own growth have increased nutrient demands which also need to be recognised.
- Strategies that promote and support exclusive breastfeeding for the first six months of life should be enhanced, and should recognise the benefits for long-term health. The greatest impact is likely to be achieved by intervening in the early postnatal weeks, when the rate of discontinuation is greatest.
The report is available here
Last reviewed September 2011. Next review due December 2014.